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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364807114
Report Date: 02/26/2024
Date Signed: 02/26/2024 11:05:22 AM


Document Has Been Signed on 02/26/2024 11:05 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501



FACILITY NAME:SBCUSD-CYPRESS ELEMENTARYFACILITY NUMBER:
364807114
ADMINISTRATOR:KELLY, LATASHIAFACILITY TYPE:
850
ADDRESS:26825 CYPRESSTELEPHONE:
(909) 388-6514
CITY:HIGHLANDSTATE: CAZIP CODE:
92346
CAPACITY:24CENSUS: 17DATE:
02/26/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:16 AM
MET WITH:Resident Teacher Diane GuzmanTIME COMPLETED:
11:09 AM
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On 02/26/2024 at time listed above Licensing Program Analyst (LPA) Steven Montoya arrived at the facility to conduct a 1 year required annual inspection. LPA was granted entry by Resident Teacher Preschool Diane Guzman. LPA toured the facility, inside and out, reviewed records, and observed and/or discussed the following:

Normal days and hours of operation are: Monday- Friday, 8:30 am-11:30am and 12:30-3:30pm

A review of the staff records and review of a sampling of children's records were conducted as part of this evaluation.

The inspection consisted of reviews of the following domains:
• Food Service
• Reporting Requirements
• Physical Plant
• Care and Supervision
• Children Records
• Staff Records
• Staffing Ratio and Capacity
• Personal Rights

The inspection found the facility to be in compliance in these domains: No deficiencies cited
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (951) 970-1161
LICENSING EVALUATOR SIGNATURE:
DATE: 02/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: SBCUSD-CYPRESS ELEMENTARY
FACILITY NUMBER: 364807114
VISIT DATE: 02/26/2024
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The licensee is asked to update the following documents, if applicable, and submit to licensing within 30 days:
1. LIC 500 Personnel Report
2. LIC 610 Emergency & Disaster Plan
3.Parent Handbook/ Program Curriculum/Admission policies and procedures/ fee schedule (only if changes have been made)
4. LIC 309 Administrative Organization
5. LIC 308 Designation of Administrative Responsibility

• The following items have been posted and are updated where necessary:
License, Emergency Disaster Plan (LIC610) and Earthquake Preparedness Checklist (LIC9148)
Parent’s Rights Poster (PUB393), Personal Rights (LIC613A); Child Car Seat Law, Menu
• The facility is operating within the terms of the license
• Ratios were met during this inspection
• Appropriate supervision was provided during this inspection
• Classrooms are equipped with age appropriate furniture and equipment in good condition
• Classrooms are clean and free of hazards
• No weapons stored at the facility
• There are no accessible bodies of water present. All wading pools or similar product must be emptied immediately after use and stored in an upright position.
• Medications are stored where inaccessible to children: Located in locked box in classroom
• Hazards are stored where inaccessible to children which include: Disinfectants, cleaning solutions and other items that are dangerous
• Poisons and toxins are locked: Located in on-site janitorial closet
• All floors are clean and safe
• Bathrooms were observed to be safe, sanitary and in operating condition
• Playgrounds are enclosed by appropriate fences and free of hazards
• Outdoor activity areas are supplied with age and size appropriate equipment in good condition:
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (951) 970-1161
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: SBCUSD-CYPRESS ELEMENTARY
FACILITY NUMBER: 364807114
VISIT DATE: 02/26/2024
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Food preparation area is clean, free of litter, rubbish and free of rodents and other vermin
• Measures are taken to keep the facility free of flies, other insects and rodents
• Food is stored appropriately and protected from contamination
• All storage containers for solid waste, including moveable bins-have tight-fitting covers and in good repair
• Menus shall be posted at least one week in advance in a place visible by the child’s authorized representative, dated and kept on file for 30 days, and made available upon request
• Uncontaminated drinking water shall be readily available both indoors and out and provided by Public water supply
• The areas around or under high climbing equipment, swings, slides, and similar equipment shall be cushioned with material that absorbs a fall: Facility has rubber flooring and grass
• Sign in/Sign out record was reviewed and meets regulation requirements: electronic records
• A Staff member is present with current Pediatric CPR/First Aid which expires on 06/2023
• Opening and closing staff member’s CPR/First Aid expires on 06/2023
• Director completed Health and Safety Training and on file
• Staff qualifications were reviewed – health screening is on file and all staff meet educational requirements and health requirements for performing assigned tasks
• Staff have received on the job training for house keeping, sanitation and universal health precautions
• Required records for children contain a medical assessment and contain the Identification and Emergency Information

Licensee was informed of the Department has inspection authority per Health and Safety Codes sections: 1596.852, 1596.853 and 1596.8535.

• Documentation of fire & earthquake drills to be conducted every six months: Last drill on 11/27/2023
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (951) 970-1161
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: SBCUSD-CYPRESS ELEMENTARY
FACILITY NUMBER: 364807114
VISIT DATE: 02/26/2024
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Licensee was informed of Unusual Incident Reporting email UnusualIncidentReportsDO09@dss.ca.gov

Reminders:
Facility representative was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

MyChildCarePlan.org – Centers and Family Child Care Homes Licensee [or facility representative] was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

- AB 1207 – Mandated Child Abuse Reporting: Child Day Care Personnel Training, beginning January 1, 2018 – Requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years.

AB2960 – Childcare and development services, online portal – Effective June 20, 2022 - This bill requires the State Superintendent of Public Instruction (SSPI), within the California Department of Education (CDE), to develop and post on CDE's website a comprehensive child care and development services online portal for families and providers by June 30, 2022.

SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (951) 970-1161
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: SBCUSD-CYPRESS ELEMENTARY
FACILITY NUMBER: 364807114
VISIT DATE: 02/26/2024
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Medical:
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm For CCCs: Incidental Medical Services (IMS) policy was discussed

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Resident Teacher Diane Guzman.

SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (951) 970-1161
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024
LIC809 (FAS) - (06/04)
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